Before submitting your application for this season's Dunedin Intermediate Lifeguard School, please check that you have all the required pre-requisites before submitting this application and your club are aware of your application.

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1. First Name (Required.)

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2. Last Name (Required.)

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3. SLSNZ Membership Number (Required.)

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4. Club (Required.)

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5. Date of Birth (Required.)

Date

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6. Age (Required.)

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7. Gender (Required.)

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8. Email Address (Required.)

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9. Contact number (cell phone) (Required.)

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 25% of survey complete.

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